The flaws of those who make the rules

Jim Leyland was a good team manager for the Detroit Tigers. He laid down the law when he needed to. But he was also very good with maintaining the morale and motivating his players. 

There’s an art to making rules. It’s better to have no rule than to create a bad one. If you make a rule, ensure it serves a purpose, and most importantly, make sure it doesn’t cause harm. Rules made just for the sake of it are pointless. Put simply: it’s better to do nothing than to do something stupid.

Rules are generally created to improve a situation—or at least attempt to. Take, for instance, administrators trying to reduce infections in the emergency room. A noble goal, no doubt.

Now, consider an example involving suction equipment. For 30 years, we’ve ensured the ER trauma rooms are ready for anything. In a CODE situation, there’s no time to set up equipment, which is why we always have the suction canister ready, tubing attached, and a Yankauer nearby.

One day, I rushed into the ER for a CODE BLUE. The doctor was ready to intubate, and I had set up the endotracheal tube. But when I went to turn on the suction—nothing. No canister, no tubing, no Yankauer.

The equipment was there, but still sealed in its packaging. It took precious minutes to unwrap and set up, slowing us down at a critical moment.

During the post-CODE debrief, we learned why. The person responsible for following Joint Commission (JCAHO) guidelines had taken the suction apart, stating that JCAHO required everything to stay packaged until use. I replied, “If JCAHO has a rule preventing us from setting up vital equipment, then that rule needs to be changed. We need it ready when it matters.”

In this case, the rule that was meant to help ended up hindering care. This exemplifies the idea of letting us do our jobs without unnecessary interference.

Several years ago, a policy was introduced requiring us to rinse out nebulizers after each treatment with sterile water. This added unnecessary time spent in the room, and despite administration's insistence, no therapist complied. Eventually, the policy was forgotten. This serves as a reminder: you can make a rule, but you can’t force compliance unless you want to monitor us constantly. However, that would only decrease morale.

To conclude, I used to attend administrative meetings regularly. One time, during a discussion about an incident, an administrator said, “We have to do something.” I cautiously replied, “It’s better to do nothing than to do something stupid.” The point is to carefully consider both the benefits and consequences of any rule you make.

To illustrate this point, consider Jim Leyland, former manager of the Detroit Tigers. After a game where a third baseman made a costly error, a reporter asked Leyland what he said to the player. Leyland responded, “I didn’t say anything. He knows what he did wrong and will take the necessary actions to correct it.” He added that if the player repeatedly made the same mistake, he might intervene. This approach of allowing individuals to learn from their mistakes, rather than enforcing unnecessary rules, is a strategy hospital administrators would do well to adopt.